A nursing home's staffing patterns and admissions trends are among the most important factors driving residents' quality of life over time, according to recently published research findings.

In nursing homes that are showing declining or mixed results in quality-of-life measures over time, increasing activity staff hours appears to make a substantial positive difference, the investigators determined. However, in nursing homes that are improving on quality-of-life indicators, registered nurse hours per resident day -- and not more activity staff involvement -- has a “positive association” with QOL.

“Perhaps high-performing facilities are more adept at engaging RNs with residents on a personal level, allowing them to develop meaningful relationships outside of the clinical encounter,” the study authors wrote. Improving facilities also were associated with having a higher number of RN hours to begin with, so these nurses might be “less squeezed” and able to facilitate activities and engagement to a greater extent than their counterparts in settings with mixed or declining QOL results, the authors speculated.

Declining facilities also were linked with more acute resident populations, suggesting a “decreasing capacity to handle more severe case mix over time,” according to the investigators.

Other nursing home characteristics, such as size and for-profit status, also were linked to QOL improvement or deterioration over time. However, the findings suggest that funding increases for staffing, along with mandatory hours for staff, might be the most effective policy changes to improve aggregate quality of life, the authors concluded. Their findings also suggest the need for “environments and programs to better accommodate sicker, frailer residents,” they wrote.

The findings were based on a four-year study of about 370 nursing homes in Minnesota, where collection of quality-of-life data is robust, the investigators explained. They considered six quality-of-life domains: environment, personal attention, food enjoyment, engagement, negative mood and positive mood.